title: Epidemiology and clinical features of community-onset bacteremia caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae.
abstract: There is limited clinical information regarding community-onset bacteremia caused by extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae. This study was performed to evaluate risk factors and clinical outcomes of community-onset bacteremia caused by ESBL-producing K. pneumoniae. A total of 435 patients with community-onset K. pneumoniae bacteremia were included and data from patients with ESBL-producing K. pneumoniae bacteremia were compared to those with non-ESBL-producing bacteremia. Isolates with ESBLs were microbiologically characterized. Of 435 patients with community-onset K. pneumoniae bacteremia, 33 (7.6%) were infected with ESBL producers, of which 25 were further classified as healthcare-associated infections. The most common underlying diseases were solid tumors (n = 20, 60.6%) and diabetes mellitus (n = 10, 30.3%), and the most common infection was intra-abdominal infection (n = 20, 60.6%). Multivariate analysis showed that corticosteroid use (odds ratio [OR] = 13.73, 95% confidence interval [CI] = 1.93-97.6, p = 0.009), percutaneous tubes (OR = 7.30, 95% CI = 2.41-22.12, p < 0.001), and prior receipt of antibiotics (OR = 5.65, 95% CI = 2.43-14.16, p < 0.001) were significant factors associated with ESBL producers. When the 30-day mortality rate was evaluated, no significant difference was found between ESBL group and non-ESBL group (12.1% [4/32] vs. 16.0% [35/192]; p = 0.429). Among 16 isolates, for which the ESBL characterization was performed by PCR, the most common types of ESBLs were SHV (n = 16) and cefotaxime-M-2 (n = 5). Pulsed-field gel electrophoresis analysis of the ESBL-producing organisms showed extensive clonal diversity. ESBL-producing K. pneumoniae is a significant cause of bacteremia, even in patients with community-onset infections, particularly in patients with corticosteroid use, percutaneous tube, prior receipt of antibiotics, or healthcare-associated infections.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jeong-a
authors.initials: JA
authors.lastname: Lee
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Eun-Jeong
authors.initials: EJ
authors.lastname: Joo
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Ha
authors.forename: Seung-Ji
authors.initials: SJ
authors.lastname: Kang
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Park
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Nam Yong
authors.initials: NY
authors.lastname: Lee
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
mesh_terms: D000279:Administration, Cutaneous; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D015897:Comorbidity; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification*; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D010802:Phylogeny; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D018440:beta-Lactam Resistance / Q000187:drug effects / Q000235:genetics*; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001618:beta-Lactamases